Dr. Mauk’s Boomer Blog

Background

Stroke, also known as cerebrovascular accident (CVA) or brain attack, is an interruption of the blood supply to the brain that may result in devastating neurological damage, disability, or death. Approximately 795,000 people in the United States have a new or recurrent stroke each year (American Stroke Association [ASA], 2012a). Stroke accounts for 1 in 18 deaths, making it the fourth leading cause of death in the United States. A death from stroke occurs every 4 minutes and the cost of stroke treatment and disability was over $73 billion dollars in 2010. Death from stroke is generally higher among females, with higher rates in Black males (67.7/100,000) and females (57.0/100,000) than in Caucasians (ASA, 2012a). In Canada, stroke is the fourth leading cause of death, affecting 50,000 people each year (Heart and Stroke Foundation of Canada, 20059).
There are two major types of stroke: ischemic and hemorrhagic. The vast majority of strokes are caused by ischemia (87%), usually from a thrombus or embolus (ASA, 2012a). The symptoms and damage seen depend on which vessels in the brain are blocked. Carotid artery occlusion is also a common cause of stroke related to stenosis

Risk Factors

Some risk factors for stroke are controllable and others are not. The most significant risk factor for stroke is hypertension. Controlling high blood pressure is an important way to reduce stroke risk. Those with a blood pressure of less than 120/80 have half the lifetime risk of stroke as those with hypertension (ASA, 2012a). Smoking 40 or more cigarettes per day (heavy smoking) increases the stroke risk to twice that of light smokers. If a person quits smoking, their risk after 5 years mirrors that of a nonsmoker, so older adults should be particularly encouraged to stop smoking.

Warning Signs

Several warning signs are common. These include:
SUDDEN numbness or weakness of face, arm or leg – especially on one side of the body.
SUDDEN confusion, trouble speaking or understanding.
SUDDEN trouble seeing in one or both eyes.
SUDDEN trouble walking, dizziness, loss of balance or coordination.
SUDDEN severe headache with no known cause (National Stroke Association, 2013)

Diagnosis

There are several tools for assessing for signs and symptoms of stroke. One easy acronym is FAST:
F stands for facial droop. Ask the person to smile and see if drooping is present.
A stands for arm. Have the person lift both arms straight out in front of him. If one is arm is drifting lower than the other, it is a sign that weakness is present.
S stands for speech. Ask the person to say a short phrase such as “light, tight, dynamite” and check for slurring or other abnormal speech.
T stands for time. If the first F-A-S checks are not normal, then one is to remember F-A-S-T that Time is important and the emergency medical system should be activated (National Stroke Association, 2012).
Older adults experiencing the warning signs of stroke should note the time on the clock and seek immediate treatment by activating the emergency response system in their area calling 911 (American Stroke Association, 2012). Transport to an emergency medical facility for evaluation is essential for the best array of treatment options. A history and neurological exam, vital signs, as well as diagnostic tests including electrocardiogram (ECG), chest Xx-ray, platelets, prothrombin time (PT), partial thromboplastin time (PTT), electrolytes, and glucose are routinely ordered. Diagnostic testing imaging may include computed tomography (CT) without contrast, magnetic resonance imaging (MRI), arteriography, or ultrasonography to determine the type and location of the stroke. The CT or MRI should ideally be done within 90 minutes so that appropriate emergency measures may be initiated to prevent further brain damage.

Treatment

The first step in treatment is to determine the cause or type of stroke. A CT scan or MRI must first be done to rule out hemorrhagic stroke. Hemorrhagic stroke treatment often requires surgery to evacuate blood and stop the bleeding.
The gold standard at present for treatment of ischemic stroke is t-PA (tissue plasminogen activator). At this time, t-PA must be given within 3 hours after the onset of stroke symptoms. This is why it is essential that older adults seek treatment immediately when symptoms begin. Only about 3 – 5% of people reach the hospital in time to be considered for this treatment (ASA, 2012d). t-PA may be effective for a select group of patients after the 3-hour window (up to 4.5 ½ hours), and this treatment window has been approved in Canada (Heart and Stroke Foundation of Canada, 2009). The major side effect of t-PA is bleeding. t-PA is not effective for all patients, but may reduce or eliminate symptoms in over 40% of those who receive it at the appropriate time (Higashida, 2005). Other, much less common procedures such as angioplasty, laser emulsification, and mechanical clot retrieval may be options for treatment of acute ischemic stroke.
To prevent recurrence of thromboembolic stroke, medications such as aspirin, ticlopidine (Ticlid), clopidogrel (Plavix), dipyridamole (Persantine), heparin, warfarin (Coumadin), and enoxaparin (Lovenox) may be used to prevent clot formation. Once the stroke survivor has stabilized, the long process of rehabilitation begins. Each stroke is different depending on location and severity, so persons may recover with little or no residual deficits or an entire array of devastating consequences.
The effects of stroke vary, and some persons may recover with no residual effects. But more often, stroke survivors may have problems that include hemiplegia or hemiparesis (paralysis or weakness on one side of the body), visual and perceptual deficits, language deficits, emotional changes, swallowing dysfunction, and bowel and bladder problems. Ninety percent of all dysphagia (swallowing problems) results from stroke (White, O’Rourke, Ong, Cordato, & Chan, 2008).

Poststroke Rehabilitation

Rehabilitation after a stroke focuses on several key principles. These include maximizing functional ability, preventing complications, promoting quality of life, encouraging adaptation, and enhancing independence. Rehabilitation emphasizes the survivor’s abilities, not disabilities, and helps him or her to work with what he or she has while acknowledging what was lost.
Stroke survivors go through a unique recovery process. This model shows the process of stroke recovery where forward progress after stroke lead to acceptance and adaptation:

If significant functional impairments are present, evaluation for transfer to an intensive acute inpatient rehabilitation program is recommended. Inpatient rehabilitation units offer the survivor the best opportunity to maximize recovery, including functional return. An interdisciplinary team of experienced experts, including nurses, therapists, physicians, social workers, and psychologists, will help the survivor and the family to adapt to the changes resulting from the stroke. Outcomes for geriatric stroke survivors are enhanced by intensive rehabilitation programs, whether offered in rehabilitation units or in skilled nursing facilities (Duraski, Denby, Danzy & Sullivan, 2012; Jett, Warren, & Wirtalla, 2005).
A large amount of teaching is often done by stroke rehabilitation nurses who work with older survivors and their families. These include knowing the warning signs of stroke and how to activate the emergency response system in their neighborhood, managing high blood pressure, understanding what medications are ordered as well as how often to take them and why, the importance of regular doctor visits, preventing falls and making the home environment safe, available community education and support groups, and the necessity of maintaining a therapeutic regimen and lifestyle to decrease the risk of complications and recurrent stroke. All survivors will need assistance in re-integrating into the community. This is generally begun in the rehabilitation setting.

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Finding the right senior care center for your loved one is a daunting task. With so many different types of care centers available, it’s important to understand the differences between them and to research the options in order to determine which one best fits your loved one’s needs. From residential care homes to assisted living facilities, there are a variety of options to consider.

There are also important factors to consider such as the quality of care provided, the cost of care, and the atmosphere of the facility. By taking the time to understand the different types of senior care centers, researching the options, and considering the factors that are important to your loved one, you can make an educated and informed decision that will ensure your loved one is receiving the best care possible. Top class hospitals also have their own senior care network which can be consulted according to one’s need.

Unlocking the Secrets to Finding the Perfect Senior Care Center for Your Loved One

Finding the right senior care center for your loved one is a daunting task. With so many different types of care centers available, it’s important to understand the differences between them and to research the options in order to determine which one best fits your loved one’s needs. From residential care homes to assisted living facilities, there are a variety of options to consider.

There are also important factors to consider such as the quality of care provided, the cost of care, and the atmosphere of the facility. By taking the time to understand the different types of senior care centers, researching the options, and considering the factors that are important to your loved one, you can make an educated and informed decision that will ensure your loved one is receiving the best care possible.

Types of Senior Care Centers

When you begin your search for the perfect senior care center for your loved one, it’s important to understand the different types of care centers available. Each type of care center offers different amenities and services, and each one is designed to meet the needs of a different type of senior.

The first type of care center is a residential care home, which is a residential home or building that provides care services for seniors. Residential care homes typically provide on-site nursing care and assistance with daily activities such as bathing, dressing, and grooming. They also provide social activities and recreational activities, as well as meals and housekeeping.

Another type of care center is an assisted living facility, which is a residential community designed to provide care and assistance with daily activities. Assisted living facilities typically offer a variety of services such as meals, housekeeping, personal care, and social activities. They also provide medical care and supervision, as well as help with mobility and other activities of daily living.

Finally, there are nursing homes, which provide more comprehensive medical care for seniors who are unable to live independently. Nursing homes offer a variety of services such as skilled nursing care, rehabilitation services, social activities, and more.

Factors to Consider When Choosing the Right Care Center

When you’re considering the different types of care centers available, it’s important to take into account the factors that are important to your loved one. It’s important to consider the quality of care provided, the cost of care, and the atmosphere of the facility.

The quality of care is an important factor to consider when choosing a care center. It’s important to make sure that the care center is providing quality care, and that the staff is experienced and knowledgeable. It’s also important to make sure that the care center is following best practices and is compliant with state and federal regulations.

The cost of care is also an important factor to consider. Different care centers have different rates, and it’s important to make sure that the care center you’re considering is affordable for you and your loved one. It’s also important to make sure that the care center is covered by your loved one’s insurance, if applicable.

Finally, the atmosphere of the facility is an important factor to consider. It’s important to make sure that the facility is clean, comfortable, and safe for your loved one. It’s also important to make sure that the staff is friendly and welcoming, and that there are activities and social opportunities available for your loved one.

Exploring Your Options

Once you’ve taken the time to understand the different types of care centers and to consider the factors that are important to your loved one, it’s time to start exploring your options. The best way to do this is to visit the care centers in person and to take a tour. This will give you a good idea of what the care center is like and whether or not it is the right fit for your loved one.

When visiting care centers, it’s important to ask questions and to observe the environment. During your visit, it’s important to ask questions about the quality of care provided, the cost of care, and the atmosphere of the facility. It’s also important to ask about the activities and social opportunities available for your loved one. This will give you a better understanding of what the care center has to offer and whether or not it is the right fit for your loved one.

Quality of Care

The quality of care is an important factor to consider when choosing a care center for your loved one. It’s important to make sure that the care center is providing quality care and that the staff is experienced and knowledgeable. It’s also important to make sure that the care center is following best practices and is compliant with state and federal regulations.

When visiting care centers, it’s important to ask questions about the quality of care provided. You should ask questions about the staff’s experience and qualifications, the types of services offered, and the protocols that are in place to ensure quality care. You should also ask about the availability of medical care and the types of treatments offered.

It’s also important to ask for references from the care center and to speak with other families who have used the care center in the past. This will give you a better understanding of the quality of care provided and whether or not it is the right fit for your loved one.

Cost of Care

The cost of care is another important factor to consider when choosing a care center for your loved one. Different care centers have different rates, and it’s important to make sure that the care center you’re considering is affordable for you and your loved one. It’s also important to make sure that the care center is covered by your loved one’s insurance, if applicable.

When visiting care centers, it’s important to ask questions about the cost of care. You should ask about the fees for services, the availability of financial assistance, and the payment plans that are available. You should also ask about any additional fees that may be associated with the care center.

It’s also important to ask about the availability of discounts or special offers for seniors. Many care centers offer discounts for seniors, so it’s important to ask about these before making a decision.

Atmosphere of the Facility

The atmosphere of the facility is another important factor to consider when choosing a care center for your loved one. It’s important to make sure that the facility is clean, comfortable, and safe for your loved one. It’s also important to make sure that the staff is friendly and welcoming, and that there are activities and social opportunities available for your loved one.

When visiting care centers, it’s important to observe the atmosphere of the facility. You should pay attention to the cleanliness of the facility, the friendliness of the staff, and the availability of activities and social opportunities. You should also take note of the overall atmosphere of the facility and whether or not it is a place that your loved one would be comfortable in.

It’s also important to ask about the security of the facility. You should ask about the safety protocols in place to protect your loved one and to ensure their wellbeing.

Questions to Ask During Your Tour

When visiting care centers, there are a few key questions that you should ask during your tour. These include:

• What services are offered? • What is the quality of care provided? • What is the cost of care? • Are there any discounts or special offers for seniors? • What is the atmosphere of the facility like? • What activities and social opportunities are available? • What is the security of the facility like? • What protocols are in place to ensure quality care?

Asking these questions will help you get a better understanding of the care center and whether or not it is the right fit for your loved one.

What to Look for During Your Visit

When visiting care centers, there are a few key things to look for during your tour. These include:

• Cleanliness: It’s important to make sure that the facility is clean and well-maintained. • Staff: It’s important to make sure that the staff is friendly and welcoming. • Activities: It’s important to make sure that there are activities and social opportunities available for your loved one. • Security: It’s important to make sure that the facility is secure and that safety protocols are in place. • Atmosphere: It’s important to make sure that the atmosphere of the facility is comfortable and welcoming.

It’s also important to take note of anything else that stands out during your visit. This will help you get a better understanding of the care center and whether or not it is the right fit for your loved one.

Making an Educated Decision

Once you’ve taken the time to understand the different types of care centers, to research the options, and to visit the care centers in person, it’s time to make an educated decision. It’s important to consider all of the factors that are important to your loved one, such as the quality of care, the cost of care, and the atmosphere of the facility.

Once you’ve taken all of these factors into consideration, it’s important to take the time to make an informed decision. It’s also important to discuss your decision with other family members and to make sure that everyone is in agreement.

Making an educated decision about the care center for your loved one is an important responsibility, and it’s important to take the time to make sure that you’re making the right decision. By taking the time to understand the different types of care centers, researching the options, and considering the factors that are important to your loved one, you can make an informed decision that will ensure your loved one is receiving the best care possible.

Conclusion

Finding the right senior care center for your loved one is a daunting task. With so many different types of care centers available, it’s important to understand the differences between them and to research the options in order to determine which one best fits your loved one’s needs. By taking the time to understand the different types of senior care centers, researching the options, and considering the factors that are important to your loved one, you can make an educated and informed decision that will ensure your loved one is receiving the best care possible.

You may have heard of rehabilitation nursing, but are you familiar with what rehabilitation nurses do and their essential role in health care? According to the Association of Rehabilitation Nurses (ARN), there are four major domains within the new competency model for professional rehabilitation nursing (ARN, 2016) that can help us understand what rehabilitation nurses do.  In this blog, we will look at the ARN model from a layperson’s viewpoint to help explain the role of the rehabilitation nurse. Rehabilitation nurses:

Promote successful living

Rehabilitation nurses do not only care for people, but they promote health and prevent disability. This means that rehab nurses engage in activities that help patients, families and communities stay healthy. Proactively, you might see rehab nurses helping with bike safety (such as promoting the wearing of helmets), car seat fairs (to keep children safe from injury), or stroke prevention through community screenings and teaching about managing risk factors. As rehab nurses, we also help patients towards self-management of existing chronic illness or disability, teaching them how to be co-managers with their health providers so they can maintain independence and have a good quality of life. Another key activity is facilitating safe care transitions. This means that rehabilitation nurses have a special skill set to know which setting of care is best for the patient to move to next and how to make this happen smoothly. For example, if Mrs. Smith has had a stroke and finished her time in acute rehabilitation in the hospital, but she lives alone and is not quite ready to go home, what is the best care setting or services for her to receive the help she needs?  Many errors, such as those with medications, happen when patients go from one place to another in the health system. Rehabilitation nurses can help persons successfully navigate these complexities and be sure that clients get the continuity of care they need and deserve.

Give quality care

The interventions or care that rehabilitation nurses provide to patients and families is based on the best scientific evidence available. Part of being a rehab nurse is staying current on the latest technology, strategies for care, and best practices. This is to ensure that all patients receive the highest standard of care possible. We stay current in many ways, including reading journal articles, attending conferences, obtaining continuing education, and maintaining certification in rehabilitation. Research shows that having more certified rehabilitation nurses on a unit decreases length of stay in the hospital. In addition, all of rehab care focuses on the patient and family as the center of the interdisciplinary team. To this end, rehabilitation nurses teach patients and families about their chronic illness or disability across many different areas including: how to take medications; managing bowel and bladder issues; preventing skin breakdown; dealing with behavioral issues that might be present with problems such as brain injury or dementia; coping with changes from a disabling condition; sexuality; working with equipment at home; and ways to manage pain.

Collaborate with a team of experts

Rehabilitation nurses are part of an interprofessional team of physicians, therapists, psychologists, nutritionists, and many others who work together for the best patient outcomes. For persons who have experienced a catastrophic injury or illness, the work of this team of experts sharing common goals will provide the best care, and rehab nurses are the ones who are with the patient 24/7 to coordinate this process. Through effective collaboration, excellent assessment skills, and communication with the rest of the team members, rehab nurses ensure that patient and families are getting well-coordinated care throughout the rehabilitation process. Remember that rehabilitation takes place in many settings, whether on the acute rehab unit, in skilled care, long-term care, or the home. The nurse’s role is to be sure that the holistic plan of care is followed by all staff and that the physicians overseeing medical care are continually informed of patient progress for the best decision-making possible.

Act as leaders in rehabilitation

 Not only do rehabilitation nurses provide direct patient care, they are also leaders in the rehabilitation arena. You might be surprised to learn that rehabilitation nurses advocate at the highest level for legislation surrounding funding and policy for those with disabilities and chronic illness, talking with Senators and Congressmen about key issues. ARN has professional lobbyists that continually watch health policy movement in Washington and keep rehab nurses informed. Rehab nurses help patients to advocate for themselves in holding government and communities accountable for needed care services. Lastly, rehab nurses share their knowledge with others. This is done in a variety of ways through conducting and publishing research, presenting at conferences, serving on local and national committees, and serving in public office. All of the leadership activities done by nurses in rehabilitation are to promote the best quality of care for patients with chronic illness and disability.

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